•Milestones can be used as a conceptual framework to define competency standards.•Milestone standards can provide a foundation to build a program of assessment.•Competency standards reflect culture ...and expectations of individual institution.•This methodology can be readily replicated at other programs.
In transitioning to competency-based surgical training, the need to clearly define competency is paramount. The purpose of this study is to define the well-prepared foundational resident using the ACGME General Surgery Milestones as our conceptual framework.
Participants reflected on their expectations of a well-prepared resident at the end of PGY1, then assigned milestone levels reflecting this level of competence for General Surgery Milestones 1.0 and 2.0. Subcompetency scores were averaged among residents and faculty. The level of the well-prepared foundational resident was determined based on the highest level within one standard deviation of faculty, resident, and total group averages.
This took place during a dedicated education retreat at a single, large academic general surgery residency program.
Key faculty stakeholders and a representative sample of residents (PGY 1-5) within our institution participated.
Eight faculty and five residents completed Milestones 1.0 and 2.0 scoring. Mean scores between faculty and residents were compared. For 1.0, mean scores for Practice-Based Learning and Improvement 3 (PBLI 3) and Interpersonal Communication Skills 3 (ICS 3) were discernably lower for residents than for faculty (PBLI 3 1.3 (0.3) v 0.9 (0.2), p = 0.01; ICS3 1.6 (0.6) v 1.1 (1), p = 0.01). Scores of 2.0 were comparable across all subcompetency domains. With this broad agreement, Milestone-based competency standards were determined. Descriptive narratives of the KSAs were created for each subcompetency, combining the determined Milestones 1.0 and 2.0 levels.
We were able to clearly define the competent foundational resident using the ACGME Milestones as a conceptual framework. These Milestone levels reflect the culture and expectations in our department, providing a foundation upon which to build a program of assessment. This methodology can be readily replicated in other programs to reflect specific expectations of the program within the larger ACGME frameworks of competency.
Background
Idiopathic clubfoot, also referred to as congenital talipes equinovarus (CTEV), is one of the most common lower limb deformities observed in newborns, leading to significant functional ...impairment if untreated. The aims of this study were to (1) assess the developmental milestones in patients with CTEV treated by the Ponseti technique, and to compare them to the unaffected controls; (2) evaluate the possible correlation between developmental milestones, severity of the deformity, and number of casts.
Materials and methods
Seventy-nine subjects were divided into two groups, CTEV group (43 patients; 72 feet) and control group (36 patients). Age, sex, affected side, attainment of babbles (BAL), independent gait (IG), and combined word (CW) were recorded for all patients. In patients with CTEV, Pirani Score (PRS), number of casts (NC), and clinical outcome were collected according to the Clubfoot Assessment Protocol (CAP), The American Orthopedic Foot and Ankle Score (AOFAS), and Foot and Ankle Disability Index (FADI).
Results
IG was achieved later later than the unaffected controls by 12/43 patients (27.9%) with CTEV and 3/36 patients in the control group (8.3%) (
p
= 0.04) and in a mean time of 16.8 ± 3.5 months and 13.2 ± 2.7 months, respectively (
p
= 0.001). In the CTEV group the mean value of CAP was 98.6 ± 4.7, of AOFAS of 98.4 ± 4.4 and of FADI equal to 99.9 ± 0.44. There were no statistically significant differences for BAL and CW; and no correlation with PRS, NC, or clinical score were identified.
Conclusion
CTEV patients managed by the Ponseti technique achieve independent gait later than the unaffected controls, although they do so within the age limit of developmental. On the other hand, the Ponseti treatment has no impact on attainment of language development.
The purpose of this study was to explore the context and mechanisms by which the first set of Milestones impacted the processes of the Clinical Competency Committee, how programs have incorporated ...the Milestones into their program, and to understand more about the resident perspective in order to improve Orthopedic Surgery Milestones.
In 2020 all 201 accredited orthopedic surgery residency programs were invited to participate in qualitative telephone interviews to assess their experience with the Milestones and complete a supplemental online survey about their Clinical Competency Committee. Participants were comprised of a self-selected sample and complemented by a purposeful sample to ensure a breadth of perspectives. Interview data were analyzed using template analysis. Survey data were analyzed with descriptive statistics.
Interviews were completed with 101 individuals from 47 programs (23% of all programs). The two overarching themes were implementation and impact of Milestones. Subthemes within implementation were substantial variability in approaches to Milestone use in curriculum and assessment, faculty development, and methods to introduce residents to the Milestones assessment framework. The large number of subcompetencies created a significant burden for almost all programs. The structure of the Milestones was also viewed as poorly aligned with the variable design of rotation schedules across programs. Milestones have the potential to offer valuable feedback for trainees and programs overall.
While some benefits were noted and most programs appreciated the intent, the structure and design of the initial set of orthopedic surgery Milestones created substantial challenges for these programs. The results of this study helped guide a revision of the Orthopedic Surgery Milestones. These results can also be used by program leadership to encourage reflection around past, current, and future utilization of the Milestones framework. Further research will be needed to determine the impact of the revision on programs.
The 2020 photovoltaic technologies roadmap Wilson, Gregory M; Al-Jassim, Mowafak; Metzger, Wyatt K ...
Journal of physics. D, Applied physics,
12/2020, Letnik:
53, Številka:
49
Journal Article
Recenzirano
Odprti dostop
Over the past decade, the global cumulative installed photovoltaic (PV) capacity has grown exponentially, reaching 591 GW in 2019. Rapid progress was driven in large part by improvements in solar ...cell and module efficiencies, reduction in manufacturing costs and the realization of levelized costs of electricity that are now generally less than other energy sources and approaching similar costs with storage included. Given this success, it is a particularly fitting time to assess the state of the photovoltaics field and the technology milestones that must be achieved to maximize future impact and forward momentum. This roadmap outlines the critical areas of development in all of the major PV conversion technologies, advances needed to enable terawatt-scale PV installation, and cross-cutting topics on reliability, characterization, and applications. Each perspective provides a status update, summarizes the limiting immediate and long-term technical challenges and highlights breakthroughs that are needed to address them. In total, this roadmap is intended to guide researchers, funding agencies and industry in identifying the areas of development that will have the most impact on PV technology in the upcoming years.
In a randomized controlled trial involving hundreds of university students, we provide relative performance feedback specifically designed to reduce low performers’ demoralization, by dynamically ...assigning students to small leaderboard groups that share a similar score in a semester-long online assignment. Treated students appear 2.6% more likely to go beyond the call-of-duty on their assignment by mid-semester. For low performers, this translates in 0.27 SDs higher exam grades, more stress, increased effort and lower procrastination. High performers are happier, procrastinate less and overachieve in the assignment on which they are ranked, but ultimately also score 0.25 SDs lower exam grades.
•We conduct a randomized controlled trial involving hundreds of university students.•Students receive relative performance feedback designed to reduce demoralization.•Treated students are 2.6% more likely to overachieve on their ranked assignment.•High performers are happier, procrastinate less and earn 0.25SDs lower exam grades.•Low performers are more stressed, exert more effort and earn 0.27SDs higher grades.
Mangrove forests are highly productive ecosystems that typically dominate the intertidal zone of tropical and subtropical coastlines. The history of mangrove remote sensing (RS) can be traced back to ...1956. Over the last six decades, hot spot topics in the field of mangrove RS have evolved from mangrove distribution mapping, biophysical parameters inversion, to ecosystem process characterization. Although several review articles have been published to summarize the progress in this field, none of them highlighted the key milestones of historical developments pertinent to major research topics or key drivers that stimulate such milestones.
In this review, we aim to identify key milestones in mangrove RS by associating the emergence of major research topics with the occurrence of new sensors in four historical phases, i.e. before 1989, 1990–1999, 2000–2009, and 2010-2018. For each identified research topic, an in-depth theoretical understanding was achieved by analyses of both the first published article and the most-cited article. Based on the analyses, the current state of knowledge as well as existing limitations were summarized. In addition, in order to gain insights on driving forces for emergence of new research topics, we compared the chronological evolution of mangrove RS with that of terrestrial forest RS.
Interestingly, we found that key research topics in mangrove RS replicated those of forest RS yet with varying time lags. This can be attributed to the following two facts: 1) mangrove forests often appear as more elongated patches than terrestrial forests; 2) field work is more challenging in mangrove habitat. Along with the RS sensors' advancement, various topics that had been studied in terrestrial forests were later transformed to mangrove studies. Based on the projected growth of foreseeing earth observation capacity, insights on future research directions in mangrove RS were also presented.
•First chronological review of mangrove remote sensing studies in six decades (1956–2018)•Identified key milestones in historical mangrove remote sensing research•Revealed that mangrove remote sensing research follows the trail of terrestrial forests•Concluded that sensor development drives the evolution of mangrove remote sensing•Provided insights on future research directions in mangrove remote sensing
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